Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email Address
*
Dog's Name
*
Dog's Birth Date
*
Dog's Current Age
*
Dog's Gender & Neutering Status
*
Please pick one option
Date when neutered (if applicable)
This can be a rough date.
MM
DD
YYYY
Date First Acquired
*
MM
DD
YYYY
Breeder's Home
If you got your dog straight from the breeder, can you describe the breeders set-up? For example, did you see the parents? Was the puppy's pen in the breeder's home?
Rescue Background
If your dog was a rescue, what do you know of their life and situation before you had them?
Have you owned a dog before?
*
Have you owned this breed before?
Main problem that you are seeking help for
*
Additional problems you would like help with
Other household members with ages
*
Other pets (cats or dogs) with ages
*
Your Dog's Vet.
*
Last Vaccination Date (Approx)
*
MM
DD
YYYY
Does your dog have any health issues at this time?
*
If yes, please describe
Is your dog currently on any medication?
If yes, please provide details.
Is your dog currently receiving any complementary therapies? (ie homeopathy?)
*
If yes, please describe.
Please tick any of the behaviours your dog undertakes at least once a week
*
Is your dog protective over any part of their body?
*
If yes, which area
Has your puppy ever attended a training class?
If yes, how old were they when they started?
Name of class / trainer
For were the training methods used?
For example, how were you taught to train a loose lead?
How old was your puppy when you first started taking them out for walks?
Were the puppies offlead or onlead in class?
How well did your dog do in class?
Did you ever attend puppy parties at your vets?
What cues does your dog do on command?
Does your dog ever pull on the lead?
*
How do you respond if / when your dog pulls on the lead?
Is your dog more obedient with some people more than others?
If yes, please give details
How do you correct your dog when they misbehave?
*
What type and brand of food do you give your dog?
*
How many times a day is the dog fed?
*
Is the dog protective around food?
*
(ie, stiffening, growling, snapping)
Is her appetite good or poor?
*
Does your dog eat quickly or slowly?
*
Is your dog given any slow feeding items such as bones, chews or stuffed kongs?
*
If yes, is your dog protective over the item? (ie hiding with it, tense body language, growl etc).
